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This Year’s Pulitzer for Sophistry

Joseph Rago, a senior editorial writer for the Wall Street Journal, won a Pulitzer Prize yesterday for a collection of pieces that mount a relentless attack on the federal health care law that he derogatorily refers to as “ObamaCare.”

Editorial writing by definition requires the author to take an opinion—and sometimes to offer prescriptive alternatives. The Pulitzer Prize board says Rago's columns are “well-crafted, against-the-grain editorials challenging the health care reform advocated by President Barack Obama.” And in the partisan battle that continues to surround health reform, clearly there is an important role for just this kind of bully pulpit. But if you read Rago’s body of work you will find editorials that are perhaps well-crafted stylistically (i.e. he’s not a bad writer), but his staunchly conservative opposition to the Affordable Care Act relies on oft-repeated mistruths. In fact, his criticisms of the health law pretty much go “with the grain” of those who have led the attack against not just the Affordable Care Act but against Obama’s leadership in general.

In fact, Rago’s series of columns promote opinions that are the standard fare on Fox News and spouted as fact by other right-wing pundits. He assails the individual mandate as unconstitutional, warns that “ObamaCare” actually is a government take-over of health care and charges that Accountable Care Organizations will lead to a dangerous consolidation of power that will increase costs by crushing competition and ending the “autonomy of independent practice.” He misstates figures concerning health spending and savings and repeats alarmist misinformation.

For example, Rago charges (in two columns, no less) that by rescinding its approval of Avastin for treatment of breast cancer, the FDA is depriving women of a life-saving treatment. Never mind that studies show the drug does not increase the aggregate life-span of late-stage breast cancer patients or that it can actually be more harmful in some patients than no treatment at all; Rago writes that “Avastin is a political target because of its high cost—a typical course runs as high as $88,000—and after ObamaCare all medical questions are inevitably political questions too.”

Here are other excerpts from some of Rago’s “against-the-grain” columns (i.e. health reform bashing) that must have helped attract the attention of the prize committee:

“With the House's climactic vote on ObamaCare tomorrow, Democrats are on the cusp of a profound and historic mistake, comparable in our view to the Smoot-Hawley tariff and FDR's National Industrial Recovery Act,” Rago writes. This shows creative use of historical references, but the editorial is inaccurate just the same.

In the same column, Rago invokes Milton Friedman, the famous free-market economist who authored a 1996 essay on national health care that draws “from Alexander Solzhenitsyn's novel "The Cancer Ward,” Rago writes. “Stripped of its romantic illusions, ObamaCare is really about who commands the country's medical resources. It vastly accelerates the march toward a totally state-driven system, in contrast to reforms that would fix today's distorted status quo by putting consumers in control.”

When throwing around cost calculations, Rago is skilled (as many opinion writers are) at leaving out important facts. He attacks the health law by telling his readers, “Once the health-care markets are put through Mr. Obama's de facto nationalization, costs will further explode. The Congressional Budget Office estimates ObamaCare will cost taxpayers $200 billion per year when fully implemented and grow annually at 8%, even under low-ball assumptions. Soon the public will reach its taxing limit, and then something will have to give on the care side. In short, medicine will be rationed by politics…”

Mr. Rago has neglected to mention that there are savings associated with various provisions of the law too. Last year, the Center for American Progress estimated that spending reductions in the Affordable Care Act would total at least $590 billion over 2010–2019 and would lead to insurance premiums being lowered by nearly $2,000 per family. “Moreover,” authors David Cutler, Karen Davis and Kristof Stremikis write, “the annual growth rate in national health expenditures could be slowed from 6.3 percent to 5.7 percent.”

In this piece, Rago takes the view that despite the media’s stance that constitutional arguments against health reform aren’t likely to derail the legislation, “the legal challenges to ObamaCare are serious and carry enormous implications for the future of American liberty.”

He asks with alarm, “If the insurance mandate stands, then why can't Congress insist that Americans buy GM cars, or that obese Americans eat their vegetables or pay a fat tax penalty?”

“As for the assertion that the mandate is really a tax, this is an attempt at legal finesse. The mandate is the legal requirement to buy a certain product, while the tax is the means of enforcement. This is not a true income or even excise tax. Congress cannot, merely by invoking a tax, blow up the Framers' attempt to restrain government under Article I.”

Skipping over a serious discussion of precedents and arguments from most Constitutional scholars that it is highly unlikely that the Supreme Court will overrule Congress in this extremely partisan matter, Rago settles for time-worn rhetoric: “Democrats may have been able to trample the rules of the Senate to pass their unpopular bill on a narrow partisan vote, but they shouldn't be able to trample the Constitution as well.”

In this tender ode to the free-market jewel that is Medicare Advantage, Rago bemoans that the government is putting new limits on these plans, predicting that many, many seniors will see their health benefits diminish (i.e. gym memberships, eyeglass coverage) as they lose access to choice and the wonders of the private insurance market.

“The politics here is that Democrats loathe Medicare Advantage because it sanctions the private choices that might eventually liberate the U.S. health market from government price controls. They also wanted to raid Advantage to finance their new subsidies.”

Nowhere in this editorial does Rago mention that the government has traditionally paid private insurers a premium of 12% or more per Medicare enrollee when compared to those opting to stay in the standard program. He also fails to mention that Medicare Advantage plans have higher administrative costs and spent just 83% of revenues on direct medical benefits. With a more restrictive network of approved doctors and higher cost-sharing for seniors in some plans, about 20% of those who sign up for MA plans leave dissatisfied and go back to traditional Medicare just one year later.

Under health reform, Medicare faces deep cuts—most will be achieved by paring out the waste, errors, overuse of treatment and poorly coordinated care that drives up prices. Rago’s beloved Medicare Advantage will be scaled back—because it is expensive and many plans are not offering the best bang for the buck. CMS recently released 2012 policies for Medicare Advantage and private prescription drug plans that will result in net savings to the Medicare program of about $76 billion for fiscal years 2011 through 2016. Most of these savings are due to the ACA’s reforms to MA payments.

In this piece, Rago rails against the Health and Human Services secretary for announcing that the agency can block health insurers from joining state health exchanges if they make “unreasonable” rate increases—in most cases, those that go beyond 10% a year. Calling this move “political thuggery,” the WSJ writer compares health insurers to companies that sell consumer products like cars or clothing:

“Like so much else in U.S. health care, no one seems to find it odd that the government is decreeing how much businesses are allowed to charge for a product that consumers want to buy, regardless of the economic reality…Politicized rate-setting is the new reality of the U.S. health insurance market, not that consumers will in any way benefit.”

In his final editorial of the collection, the future-Pulitzer-Prize winning Rago attacks a past winner of the vaunted award: PolitiFact, a project of the St. Petersburg Times that won the Pulitzer Prize in National Reporting in 2009 for coverage of the 2008 elections. PolitiFact, a non-partisan political watchdog, operates a “truth-o-meter” that attempts to separate facts from myths in public statements made by elected officials, pundits and other political figures. The Pulitzer board cited PolitiFact's use of “probing reporters and the power of the World Wide Web to examine more than 750 political claims, separating rhetoric from truth to enlighten voters."

For Rago, these accolades fall on deaf ears. At the end of 2010, PolitiFact declared that the “lie of the year” is the common reference to the new health care bill as “a government takeover of health care.” The group supports its point by noting that the vast majority of health insurers, hospitals and doctors are not employed by the government and much of reform hinges on smarter regulation and operation of the private health care marketplace.

Rago, predictably, does not agree with that assessment. He writes, “PolitiFact's decree is part of a larger journalistic trend that seeks to recast all political debates as matters of lies, misinformation and ‘facts,’ rather than differences of world view or principles. PolitiFact wants to define for everyone else what qualifies as a 'fact,' though in political debates the facts are often legitimately in dispute.” He seems to miss the point that no matter how you spin it (or whatever your world view), it just is not a fact that the government is—like in Canada and England, for example—taking over health care. The complicated (and some would say, imperfect) plan we find ourselves pushing forward with is balky because it insists on creating universal health coverage within a private-industry framework.

By devoting the rest of his final column in this series to using semantics and sketchy arguments to support his government-takeover charge, Rago continues to feed this insidious lie. It’s hard to believe that this clumsy attack on PolitiFact, a non-partisan, fact-checking organization—along with Rago’s other inflammatory and factually deficient columns make up the body of work that the Pulitzer board admired as “well-crafted,” “against the grain” editorials.

Stating that Obamacare is derogatory is becoming a tired canard. Naomi, what do you think of the term Bush Tax Cuts? The only thing I see is one group that is unafraid to link a their president with his signature piece of legislation, while the other group must be ashamed to. That is the only reasonable explanation. If the law is as good as you think it is, love it, embrace it, demand to call it nothing less than Obamacare.

Great point Jenga, one which is so often lost until pointed out. The feeling is natural of course when one has an emotionally positive connection with the name in question.
Not that I care, but it is important to understand from whence things come.
Luckily, I make up my own mind, but I appreciate the opinions of others.